Supercoder Blog

Coding can go wrong even for the most simple of treatments. A wrong CPT® code can be assigned if the coding dynamics revolving around strapping are not understood well. It is important to understand coding principles that will help in using the correct CPT codes for strapping. The following pointers will help you in applying the right codes:

Understand Payers Definitions

The first thing that needs to be done is to understand payer’s definition of strapping. Additionally, identify the method of strapping used. One method of strapping is Una boot which is basically a paste bandage. The CPT code for Una booth application is 29580. Another method of strapping is “buddy splint” which is canvas or foam strap. The CPT code for buddy splint is 29280(hand or finger) or 29550 (toes).

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There is regular and constant scrutiny over physician practices by OIG and other audit agencies. The scrutiny is well founded with the large volume of pay backs which occurred last year. As per 2013 OIG work plan, they intend to keep a number of things under their microscope for auditing purposes. Physician practices should be cautious in their documentation and assigning the appropriate CPT codes. Practices should focus on making the deserved claims and not on maximizing unethical payments. With the regular CPT Changes., practices will be well served in staying up to date with all the modifications happening in CPT®. OIG will keep reviewing claims and practices should try to resolve below mentioned issues before they get marked for audit. A brief glimpse at some of the notable issues which OIG has set eyes upon are:

(a) E/M services and cloning documentation: The OIG will review all the E/M notes. As per OIG Work Plan 2013 “We will determine the extent to which CMS made potentially inappropriate payments for E/M services in 2010 and the consistency of E/M medical review determinations”. Practices should pay special attention to documentation. If patient’s documentation is identical, it might result in OIG audit.
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Earlier, certain procedures during endoscopy were reported using unlisted codes. CPT 2013 introduced new codes for optimal endoscopy. Now general surgeon performing optical endoscopy has the codes available to report the complete procedure.
CPT code 43206: Surgeon can use this code when they perform esophagoscopy, rigid or flexible; with optimal endomiscroscopy.
CPT code 43252: This CPT code can be used when surgeon performs upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with optimal Endomicroscopy.
It may become hard to discern the applicability of the codes. However the CPT code can easily be distinguished. In the procedure, if the surgeon examines a patient’s esophagus, stomach and duodenum using high-resolution imaging, CPT code 43252 will be used. On the other hand, if the surgeon examination does not go all the way to duodenum or jejunum, CPR code 43206 will be used.
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The only audits that cross one’s mind are the OIG Audit, RAC’s Audit, MFCU’s Audit and any other similar enforcing agencies audit. You may never have considered going for an internal audit. But self-audit can certainly help in finding out the chart discrepancies and could potentially improve reimbursements as well. By going for internal audit, it can be easily determined that all the things are in order and well documented. If every bill is documented in a proper manner, it can save you lots of money as well as any compliance repercussions.

What Internal Audit entails?

An internal audit process includes a complete run down of all the billing records, claims and medical records to verify the treatment outcomes along with their medical necessity. For each medical service provided, there should be supporting documents along with reasonable charges for the rendered service. In an audit, all members of the practice need to be involved. Before carrying an audit, it is beneficial to communicate the same to staff members of the practice so that all requisite preparation from their end can be made.

Tips for First Time Auditors:

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